PipTree. Arthrodesis of the PIP joint

Transcription

1 Arthrodesis of the PIP joint

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3 Table of Contents Introduction PipTree 2 System Characteristics 2 Indication 2 Surgical Technique Access 3 Osteotomy 3 Preparation of the proximal phalanx 3 Preparation of the middle phalanx 4 Insertion of the implant 4 Tips and tricks 5 Follow-up treatment 5 Product Information Implants 6 Instruments 7 Instrument Tray 7 Notes 8 Note: The surgical technique outlined below reflect the surgical procedure usually chosen by the clinical advisor. However, each surgeon must decide which surgical method and which approach is the most successful for his patient. Page 1

4 Introduction PipTree Implant for intramedullary arthrodesis on the proximal interphalangeal (PIP) joint of the small toes. Various procedures are available for osteosynthesis to correct contracted claw toe. The classical Kirschner wire has various disadvantages here. The Kirschner wire prevents the physiological flexion position of the toe in the proximal interphalangeal joint. The osteosynthesis material protruding on the toes is associated with a certain risk of infection and has to be removed again after the appropriate time. System Characteristics The PipTree implant is an intramedullary load-bearing element, which enables stable osteosynthesis of the toe in a physiological position This easy-to-insert titanium implant allows the toe to be fixed in the required flexion position of 0, 10 or 20 The different flexion angles are designated by different colour codes: 0 (green), 10 (blue) and 20 (gold) The time for bone healing is around six weeks Removal of metal is not necessary The functional yet simple implant design was developed on the basis of established implant geometries and represents a significant advancement in arthrodesis at the proximal interphalangeal joint of the small toes Particularly the stable anchoring in the bone with high rotational and primary stability, while maintaining the physiological flexion position and its fully intraosseous placement, are of enormous benefit to the patient Indication Contracture malposition of the proximal interphalangeal joint of toes II-IV In combination with correction of hallux valgus Page 2

5 Surgical Technique Access Longitudinal or transverse access to the proximal interphalangeal joint of the toes Longitudinal split of the extensor tendon without detaching it completely from the middle phalanx Osteotomy Resection of the proximal phalangeal head, analogous to classical arthrodesis of the joint with K-wire osteosynthesis As the bone surfaces should be in contact, extensive resection should be avoided A The resection of the bone surfaces should be slightly divergent to plantar, according to the planned angulation of implant B A B Preparation of the proximal phalanx Instrumente REF REF Drill Bit Ø 2.5 mm, proximal Router Ø 2.5/3.3 mm A Drill a central hole with the proximal drill bit in the cancellous bone of the proximal phalanx until the stop ring of the drill rests on the bone A Further prepare the anchor hole with the pilot countersink B B Page 3

6 Preparation of the middle phalanx Instrumente REF Drill Bit Ø 2.5 mm, distal Drill a central hole with the distal drill bit in the cancellous bone of the middle phalanx in the depth predetermined by the drill Insertion of the implant Instrumente REF Holding Forceps Note: The curvature of the implant should be selected on the basis of the other toes. Angulations of 0, 10 and 20 are available. Hold the implant with the holding forceps Push the implant into the proximal phalanx with slight twisting until only the distal anchoring pin is still visible The laser marking allows precise positioning of the angulation in the sagittal plane of the toe Subsequently place the middle phalanx on the distal anchoring pin Push the middle phalanx on the anchoring pin until there is surface bone contact Remove bone protrusions in the marginal areas using the luer Suture the extensor tendon to further stabilise the fused joint against dislocation taking the rotational position of the toe into consideration An additional thread or wire cerclage is possible Monitor the outcome of surgery with the image intensifier in two planes Page 4

7 Tips and tricks In case of a narrow medullary canal, fix the proximal phalanx with a Kocher clamp, then slide the PipTree in with slight rotation. In case of a narrow joint situation, slide the PipTree somewhat deeper into the proximal phalanx. This can reduced the length of the distal anchoring by up to 2 mm. This process is also recommended with a very short middle phalanx (e.g. fourth toe). Follow-up treatment Four weeks surgical shoe No mobilisation of the proximal interphalangeal joint and no traction on the toe The metatarsophalangeal joint can be exercised Page 5

8 Product Information Implants PipTree Angle: 10 and 20 Shaft diameter: 2.20 mm Thread diameter: 2.80 mm Core diameter: 1.80 mm Material: Ti6Al4V Article Number Angle Distal Proximal Colour mm 12 mm blue mm 12 mm gold PipTree Angle: 0 and 10 Shaft diameter: 2.20 mm Thread diameter: 2.50 mm Core diameter: 1.80 mm Material: Ti6Al4V Article Number Angle Distal Proximal Colour mm 12 mm green mm 12 mm blue Page 6

9 Instruments PipTree Drill Bit Ø 2.5 mm, distal, AO Coupling, L 49/9 mm PipTree Holding Forceps PipTree Drill Bit Ø 2.5 mm, proximal, AO Coupling, L 55/15 mm PipTree Router Ø 2.5/3.3 mm, AO Coupling, L 47/7 mm Instrument Tray Page 7

10 Notes PipTree Page 8

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12 Dieter Marquardt Medizintechnik GmbH Robert-Bosch-Str Spaichingen Telefon: +49 (0) 7424 / Telefax: +49 (0) 7424 / info@marquardt-medizintechnik.de Ausgabedatum: ; ; Rev.: 001/00